Situating commercial determinants of health in their historical context: a qualitative study of sugar-sweetened beverages in Jamaica.

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of mortality across the Caribbean and similar regions. Structural determinants include a marked increase in the dependency on food imports, and the proliferation of processed foods, including sugar-sweetened beverages (SSBs). We focused on Jamaica as a case study and the health challenge of SSBs, and situated contemporary actions, experiences and policies within their historical context to investigate underlying drivers of commercial determinants of health and attempts to counter them. We asked: how can a historical perspective of the drivers of high level SSB consumption in Jamaica contribute to an enhanced understanding of the context of public health policies aimed at reducing their intake? METHODS: An ethnographic approach with remote data collection included online semi-structured interviews and workshops with 22 local experts and practitioners of health, agriculture and nutrition in Jamaica and attending relevant regional public webinars on SSBs and NCD action in the Caribbean. Our analysis was situated within a review of historical studies of Caribbean food economies with focus on the twentieth century. Jamaican and UK-based researchers collected and ethnographically analysed the data, and discussed findings with the wider transdisciplinary team. RESULTS: We emphasise three key areas in which historical events have shaped contextual factors of SSB consumption. Trade privileged sugar as a cash crop over food production during Jamaica's long colonial history, and trade deregulation since the 1980s through structural adjustment opened markets to transnational companies. These changes increased Jamaican receptiveness to the mass advertisement and marketing of these companies, whilst long-standing power imbalances hampered taxation and regulation in contemporary public health actions. Civil society efforts were important for promoting structural changes to curb overconsumption of SSBs and decentring such entrenched power relations. CONCLUSION: The contemporary challenge of SSBs in Jamaica is a poignant case study of commercial determinants of health and the important context of global market-driven economies and the involvement of private sector interests in public health policies and governance. Historically contextualising these determinants is paramount to making sense of the sugar ecology in Jamaica today and can help elucidate entrenched power dynamics and their key actors.

Repurposing NGO data for better research outcomes: a scoping review of the use and secondary analysis of NGO data in health policy and systems research.

BACKGROUND: Non-governmental organisations (NGOs) collect and generate vast amounts of potentially rich data, most of which are not used for research purposes. Secondary analysis of NGO data (their use and analysis in a study for which they were not originally collected) presents an important but largely unrealised opportunity to provide new research insights in critical areas, including the evaluation of health policy and programmes. METHODS: A scoping review of the published literature was performed to identify the extent to which secondary analysis of NGO data has been used in health policy and systems research (HPSR). A tiered analytical approach provided a comprehensive overview and descriptive analyses of the studies that (1) used data produced or collected by or about NGOs; (2) performed secondary analysis of the NGO data (beyond the use of an NGO report as a supporting reference); and (3) analysed NGO-collected clinical data. RESULTS: Of the 156 studies that performed secondary analysis of NGO-produced or collected data, 64% (n = 100) used NGO-produced reports (mostly to a limited extent, as a contextual reference or to critique NGO activities) and 8% (n = 13) analysed NGO-collected clinical data. Of these studies, 55% (n = 86) investigated service delivery research topics and 48% (n = 51) were undertaken in developing countries and 17% (n = 27) in both developing and developed countries. NGOs were authors or co-authors of 26% of the studies. NGO-collected clinical data enabled HPSR within marginalised groups (e.g. migrants, people in conflict-affected areas), albeit with some limitations such as inconsistent and missing data. CONCLUSION: We found evidence that NGO-collected and produced data are most commonly perceived as a source of supporting evidence for HPSR and not as primary source data. However, these data can facilitate research in under-researched marginalised groups and in contexts that are hard to reach by academics such as conflict-affected areas. NGO-academic collaboration could help address issues of NGO data quality to facilitate their more widespread use in research. The use of NGO data use could enable relevant and timely research in the areas of programme evaluation and health policy and advocacy to improve health and reduce health inequalities, especially in marginalised groups and developing countries.

Joined-up governance for more complementary interactions between expanding artisanal small-scale gold mining and agriculture: Insights from Ghana.

Rising gold prices have led artisanal and small-scale gold mining (ASGM) operations to proliferate in sub-Saharan Africa, extending into agricultural areas. Little is known about the interactions between agriculture and mining in these new frontiers. This study aimed to investigate the impacts of ASGM on natural and physical livelihood capitals, ASGM's interactions with agriculture at household, community and institutional levels and the drivers underpinning those interactions, and the policy implications for the co-existence of sustainable agriculture and ASGM. Alongside literature review, field-work took place in Atiwa West District and Koforidua, Ghana using environmental field surveys, questionnaires, focus group discussions and interviews. Questionnaire and field survey data were analysed using descriptive statistics, with thematic analysis of interviews and focus group data. Findings revealed that most miners were unregulated, mined irresponsibly and degraded land, waterways, and farm roads. Over one-third of farmers (38%) suffered land degradation, and 79% of affected farmers' lands were not reclaimed. Farmers diversified into ASGM, and mining proceeds boosted farming. Young farmers (18-40 years) shifted into ASGM full-time because it is more lucrative. Yet, ASGM is not replacing agriculture: cocoa farming remains a vital economic activity. Informal ASGM generates short-term income at household level for some but imposes long-term costs at community level, linked to cumulative loss of agricultural land and degradation of forest areas and water bodies, creating tensions, and increasing vulnerability. Financial hardships faced by farmers, landowners' desire to benefit directly from gold and lack of law enforcement drive informal ASGM. There are no institutional linkages between the agricultural and mining sectors. More joined up governance across agriculture and mining is needed and between formal and informal (traditional) institutions. ASGM should be incorporated into broader rural development policy reforms that support farmers, incentivise miners to operate legally and responsibly and ensure effective stakeholder engagement.

Tackling child malnutrition in Jamaica, 1962-2020.

On the eve of independence in 1962, malnutrition was the largest single cause of death in Jamaica for children under one. Although child malnutrition rates have rapidly declined since 1962, today Jamaica experiences a double burden of malnutrition: the coexistence of pockets of high child malnutrition with rising levels of childhood obesity. Based on a wide range of sources, including public documents, newspaper reports, scientific studies and reports by international agencies, this article examines a gradual decline in child malnutrition and the rise of the double burden of malnutrition in Jamaica from independence to the present. It will first of all show that changes in the global economy and overseas loans and aid both aided and limited the ability of the Jamaican government to lower child malnutrition levels and also contributed to a rise in childhood obesity. Second, it will illustrate that a traditional deficit-led approach to child malnutrition was followed in post-independent Jamaica, focussing on the public and individuals as targets for intervention and using quantitative measures to trace progress. And third, it will question whether the double burden of child malnutrition will give rise to 'healthy publics'-'dynamic collectives of people, ideas and environments that can enable health and well-being'.

The black scourge? Race and the Rockefeller Foundation's tuberculosis commission in interwar Jamaica.

From 1927 to 1942, the Rockefeller Foundation ran a tuberculosis commission in Jamaica that researched the epidemiology of the disease, examined the efficacy of a vaccine with heat-killed tubercle bacilli, and offered basic treatment to tuberculosis sufferers. Drawing upon diaries and scientific writings by the staff employed by the commission, among other sources, this article explores the role that race played in the tuberculosis commission. It assesses how race shaped the research conducted by the commission, how it informed staff interactions and staff/patient relations, and the clash and/or confluence of "imported" and local racial ideas in the commission's work.

'Fight TB with BCG': mass vaccination campaigns in the British Caribbean, 1951-6.

Based on a wide range of primary materials, including WHO reports and Colonial Office correspondence, this article examines the UNICEF/WHO-funded mass BCG campaigns that were carried out in seven Caribbean colonies between 1951 and 1956. It explores the reasons behind them, their nature and aftermath and also compares them to those in other non-European countries and discusses them within a context of decolonisation. In doing so, it not only adds to the scholarship on TB in non-European contexts, which had tended to focus on Africa and Asia, but also to the relatively new field of Caribbean medical history and the rapidly expanding body of work on international health, which has paid scant attention to the Anglophone Caribbean and the pre-independence period.

The black scourge? Race and the Rockefeller Foundation’s tuberculosis commission in interwar Jamaica

From 1927 to 1942, the Rockefeller Foundation ran a tuberculosis commission in Jamaica that researched the epidemiology of the disease, examined the efficacy of a vaccine with heat-killed tubercle bacilli, and offered basic treatment to tuberculosis sufferers. Drawing upon diaries and scientific writings by the staff employed by the commission, among other sources, this article explores the role that race played in the tuberculosis commission. It assesses how race shaped the research conducted by the commission, how it informed staff interactions and staff/patient relations, and the clash and/or confluence of “imported” and local racial ideas in the commission’s work. (AU)

The black scourge? Race and the Rockefeller Foundation's tuberculosis commission in interwar Jamaica / O "flagelo negro"? Raça e a comissão de tuberculose da Fundação Rockefeller na Jamaica do entreguerras

From 1927 to 1942, the Rockefeller Foundation ran a tuberculosis commission in Jamaica that researched the epidemiology of the disease, examined the efficacy of a vaccine with heat-killed tubercle bacilli, and offered basic treatment to tuberculosis sufferers. Drawing upon diaries and scientific writings by the staff employed by the commission, among other sources, this article explores the role that race played in the tuberculosis commission. It assesses how race shaped the research conducted by the commission, how it informed staff interactions and staff/patient relations, and the clash and/or confluence of "imported" and local racial ideas in the commission's work.

De 1927 a 1942, a Fundação Rockefeller criou uma comissão da tuberculose na Jamaica que pesquisou a epidemiologia da doença, verificou a eficácia de uma vacina com bacilos da tuberculose que morriam com o calor e ofereceu tratamento básico para pacientes com tuberculose. Com base em anotações e textos científicos do grupo contratado para a tarefa, este artigo investiga a função da raça na comissão da tuberculose. Ele avalia como a raça moldou a pesquisa conduzida, como ela informou interações na equipe e relações equipe/paciente, e o confronto e/ou a confluência de ideias raciais "importadas" e locais no trabalho da comissão.

‘Fight TB with BCG': Mass Vaccination Campaigns in the British Caribbean, 1951–6

Based on a wide range of primary materials, including WHO reports and Colonial Office correspondence, this article examines the UNICEF/WHO-funded mass BCG campaigns that were carried out in seven Caribbean colonies between 1951 and 1956. It explores the reasons behind them, their nature and aftermath and also compares them to those in other non-European countries and discusses them within a context of decolonisation. In doing so, it not only adds to the scholarship on TB in non-European contexts, which had tended to focus on Africa and Asia, but also to the relatively new field of Caribbean medical history and the rapidly expanding body of work on international health, which has paid scant attention to the Anglophone Caribbean and the pre-independence period. (AU)